Wiki treating family

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melonie_lockard@yahoo.com

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I have a provider who keeps treating her daughter. She has ordered labs and given immunizations to her. I have told her that she can not treat family and my higher up people are saying that she can. My question is where does it state that providers do not need to treat family and friends so I can show them? Any help is apprecitated.

Thanks,
Melonie Taylor, CPC:)
 
It is my understanding that there is no specific regulation that says they cannot treat their own family. Many do frown upon the idea but no rule other than for billing all the same rules apply for medical necessity and such
 
melonie_lockard@yahoo.com said:
I have a provider who keeps treating her daughter. She has ordered labs and given immunizations to her. I have told her that she can not treat family and my higher up people are saying that she can. My question is where does it state that providers do not need to treat family and friends so I can show them? Any help is apprecitated.

Thanks,
Melonie Taylor, CPC:)
Click to expand...

I can provide a citation from CMS:

Section 130...

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c16.pdf
 
While CMS does not allow you to bill the Medicare program for treating family and household members (see their article for CMS's definition of family and household members), it does NOT prohibit the provider from treating them. On the contrary, it says that "The intent of this exclusion is to bar Medicare payment for items and services that would ordinarily be furnished gratuitously because of the relationship of the beneficiary to the person imposing the charge." In other words, CMS recognizes that doctors DO treat their relatives, but understands that the provider generally does not bill them.

On the other hand, see this article from the AAFP at http://www.aafp.org/fpm/2005/0300/p41.html in which they quote the AMA's Code of Ethics "that states that 'physicians generally should not treat themselves or members of their immediate families' because their professional objectivity may be compromised in those situations. Exceptions are allowed for 'short-term, minor problems' or 'in emergency or isolated settings.'" The article also quotes the Ethics Manual of the American College of Physicians in stating "that 'physicians should avoid treating themselves, close friends or members of their own families' [and] goes on to comment that 'physicians should be very cautious about assuming the care of closely associated employees.'" Note, however, that the article also points out that nearly all doctors engage in these practices anyway!
 
It really depends on each state's laws.

Some will go as far to yank your license, others don't seem to bat an eye.

Narcotic prescribing will get you in trouble everywhere.

What is legal is one thing, ethical another, and billable yet another.

Hope this helps muddy the water a bit for you. ;)
 
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